Provider Demographics
NPI:1730415498
Name:MANNING, MAXWELL (PHD)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 LENSTROM FRIEND CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1765
Mailing Address - Country:US
Mailing Address - Phone:410-505-5915
Mailing Address - Fax:
Practice Address - Street 1:2512 N CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-4645
Practice Address - Country:US
Practice Address - Phone:410-505-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD090051041C0700X
DCLC500780091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical